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OHIO HEALTH AND ACCIDENT INSURANCE QUESTIONS XCEL
"Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage? a) standard deductible b) combined deductible c) integrated deductible
d) blended deductible - CORRECT ANSWER c) integrated deductible"
"Which is likely to occur when life or health insurance is being applied for? a) The medical information bureau (MIB) will determine the risk classification b) The agent is required to report all medical information to the medical information bureau (MIB) c) Physical examinations are required
d) Medical history from the insured may be reviewed and reported - CORRECT ANSWER d)
Medical history from the insured may be reviewed and reported" "Advertisements for accident and health policies that ONLY cover a stated illness MUST display a statement that the a) policy premiums remain level b) policy is limited c) policy is guaranteed issued
d) policy covers any illness or accident - CORRECT ANSWER b) policy is limited"
"In what form do disability income policies typically pay benefits? a) lump sum b) periodic income c) tax credit
d) annuity - CORRECT ANSWER b) periodic income"
"The reinstatement provision in a health insurance policy is a) mandatory b) optional
c) voluntary
d) discretionary - CORRECT ANSWER a) mandatory"
"In an insurance contract, the element that shows each party is giving something of value is called a) offer b) acceptance c) consideration
d) purpose - CORRECT ANSWER c) consideration"
"All of these are characteristics of a major medical expense policy EXCEPT a) large benefit maximums b) deductibles c) elimination periods
d) coinsurance - CORRECT ANSWER c) elimination periods"
"Unmarried children who are incapable of self support and have proof of incapacity are included under their parent's health coverage until a) Policy termination b) policy renewal c) age 18
d) age 19 - CORRECT ANSWER a) Policy termination"
"A common exclusion or limitation on a dental policy is a) endodontics b) tooth extractions c) flouride treatments
d) x-rays - CORRECT ANSWER a) endodontics"
"All _____ policies must be guaranteed renewable a) dental b) long-term care
"Coordination of benefits regulation applies to all of the following plans EXCEPT a) Group vision plan b) Preferred Provider Organization Plan c) self-funded group health plan
d) group health plan - CORRECT ANSWER b) preferred provider organization plan"
"An agent's license may only be suspended or revoked if the agent a) has been afforded a right to a hearing b) has engaged in replacement of an existing policy c) filed for bankruptcy
d) did not meet sales quota - CORRECT ANSWER a) has been afforded a right to a hearing"
"An insurer can exclude coverage for a preexisting condition on a Medicare Supplement policy for up to a) 6 months b) 9 months c) 12 months
d) 18 months - CORRECT ANSWER a) 6 months"
"A disability policyowner is injured and becomes totally disabled. The benefits pay for 2 years, starting from the date of the injury. What is this time period called? a) recurrent period b) probationary period c) benefit period
d) elimination period - CORRECT ANSWER c) benefit period"
"All of the following are qualifications for establishing a health savings account (HSA) EXCEPT a) Enrolled in a high deductible plan b) Be under the age of 65 (not enrolled in medicare) c) Enrolled in a health plan with a prescription drug benefit
d) Enrolled in a health plan that limits out of pocket expenses - CORRECT ANSWER c) Enrolled
in a health plan with a prescription drug benefit"
"A Medicare Supplement basic benefit is a) the first 3 pints of blood per year b) respite care c) disability income
d) term life insurance - CORRECT ANSWER a) the first 3 pints of blood per year"
"States that have "no loss no gain" laws require a replacing policy to a) keep the same type of coverage as the policy replaces b) not charge a different premium from the policy it replaces c) pay for any half of any ongoing claims under the policy it replaces
d) pay for ongoing claims under the policy it replaces - CORRECT ANSWER d) pay for ongoing
claims under the policy it replaces" "The typical long-term care insurance policy is designed to provide a minimum of _____ year(s) of coverage: a) 1 b) 3 c) 5
d) 7 - CORRECT ANSWER a) 1"
"If an agent is believed to be causing considerable harm, the superintendent a) may incarcerate the agent b) may suspend the agent's license without a hearing c) may issue a cease and desist order against the agent
d) may take away the agent's appointment - CORRECT ANSWER c) may issue a cease and
desist order against the agent" "Health insurance involves two perils, accident and ________ a) death b) sickness c) disability
d) liability - CORRECT ANSWER b) sickness"
d) Individual disability income insurance premiums - CORRECT ANSWER a) Long Term care
insurance premiums" "How much does Medicare Part B pay for physician fees? a) 40% b) 60% c) 80%
d) 100% - CORRECT ANSWER c) 80%"
"An insurance company needs to obtain personal information from a third party concerning an applicant. Which law do all insurers and their producers need to comply with? a) USA Patriot Act b) Personal Information Act c) Fair Credit Reporting Act
'd) McCarren-Ferguson Act - CORRECT ANSWER c) Fair Credit Reporting Act"
"Which of the following nursing home options would BEST suit an individual who needs some nursing care and supervision but NOT full-time care? a) Custodial care homes b) Assisted living facilities c) Skilled nursing facilities
d) Congregate housing - CORRECT ANSWER b) Assisted living facilities"
"The role of the federal government was expanded when Medicaid was established by allowing the state to a) form a large PPO on a statewide level b) purchase health insurance from the federal government c) receive matching funds to expand public assistance programs
d) defer all costs to the federal government for public assistance programs - CORRECT
ANSWER c) receive matching funds to expand public assistance programs"
"An indemnity plan a) pays both the insured and health care provider
b) provides the insured a specific dollar amount for services c) pays the health care provider directly for services rendered
d) is typically issued as a group plan - CORRECT ANSWER b) provides the insured a specific
dollar amount for services" "An agent has committed an insurance crime that violates US Code 1033 (interstate commerce). Who would be responsible for the prosecution of this crime? a) US Attorney General b) Superintendent c) Lieutenant Governor
d) State Senate - CORRECT ANSWER a) US Attorney General"
"All of the following may be an unfair claims practice EXCEPT a) Turning down a claim without providing the basis of denial b) Denying an insured's fraudulent claim c) Failing to promptly acknowledge pertinent communications concerning claims
d) Failing to effectuate prompt, fair, and equitable settlements of a claim - CORRECT ANSWER
b) Denying an insured's fraudulent claim" "According to HIPPA, when an insured individual leaves an employer and immediately begins working for a new company that offers group health insurance, the individual a) Is eligible upon hire b) Must wait 360 days to be eligible for coverage c) Must continue coverage with previous employer
d) Is eligible for only health insurance, not life or accidental insurance - CORRECT ANSWER a)
Is eligible upon hire" "An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called a a) loss chart b) benefit summary c) benefit schedule
d) coverage menu - CORRECT ANSWER c) benefit schedule"
"An advertisement for an insurance product may contain a) the Guaranty Fund's endorsement for this product b) exaggerated benefit amounts c) deceptive information
d) the insurer's name - CORRECT ANSWER d) the insurer's name"
"A pharmacy benefit covers prescription drugs derived from a list called a(n) a) administrative drug list b) drug formulary c) controlled substance list
d) generic benefit manager - CORRECT ANSWER b) drug formulary"
"When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? a) Relation of earnings to insurance provision b) Change of occupation provision c) Conformity of state statues provision
d) Modified occupation provision - CORRECT ANSWER b) Change of occupation provision"
"An insurer has the right to recover payment made to the insured from the negligent party. These rights are called a) contributory b) indemnity c) estoppel
d) subrogation - CORRECT ANSWER d) subrogation"
"What percentage of a participant's income are group long-term disability benefit amounts typically limited to? a) 30% b) 40% c) 50%
d) 60% - CORRECT ANSWER d) 60%"
"An example of a health insuring corporation (HIC) specialty care provider is a(n) a) neurologist b) general practitioner c) family medicine physician
d) HIC medical doctor - CORRECT ANSWER a) neurologist"
"An insurance producer is often responsible for field underwriting during the application process. All of these are possible field underwriting roles EXCEPT a) providing disclosure information to the applicant b) collecting initial premium c) policy delivery
d) providing commission information to the applicant - CORRECT ANSWER d) providing
commission information to the applicant" "Which of the following provides Medicare supplement policies? a) Medicare b) Medicaid c) Private insurance companies
d) Associations and employers - CORRECT ANSWER c) Private insurance companies"
"Claims payable to a Disability Income insured, even when the insured can continue to work, are the result of a a) Total disability b) Recurrent disability c) Presumptive disability
d) Lengthy elimination period - CORRECT ANSWER c) Presumptive disability"
"People with higher loss exposure have the tendency to purchase insurance more often than those at average risk. This is called a) risk retention b) preexisting conditions c) law of large numbers
d) adverse selection - CORRECT ANSWER d) adverse selection"
b) Accident, medical care, and rehabilitation c) Psychological, acute care, and assisted living
d) Skilled nursing, intermediate, and custodial care - CORRECT ANSWER d) Skilled nursing,
intermediate, and custodial care" "Which of these do NOT provide primary care to HIC members? a) Family medicine physician b) Surgeon c) Pediatrician
d) General practitioner - CORRECT ANSWER b) Surgeon"
"Which type of plan would be most appropriate for an individual on Medicare and is concerned that Medicare will NOT pay for charges exceeding the approved amount? a) Medicaid b) Long-Term care c) Medicare supplement Plan F
d) Comprehensive major medical - CORRECT ANSWER c) Medicare supplement Plan F"
"An insurance company advertises an accident and health insurance product in a local Ohio newspaper and refers to dollar amount benefits. This insurer must also disclose which of the following in the advertisement? a) The Superintendent's signature endorsement b) The number of claims filed in the previous year c) Any applicable benefit reduction
d) The company's underwriting guidelines - CORRECT ANSWER c) Any applicable benefit
reduction" "An employer with under 20 employees must allow a terminated employee to continue accident and health coverage for a MINIMUM of ___ months a) 3 b) 6 c) 12
d) 18 - CORRECT ANSWER c) 12"
"Medical expense Insurance would cover
a) an injury occurring at the insured's residence b) an injury occurring at work c) an injury caused by war
d) elective surgeries - CORRECT ANSWER a) an injury occurring at the insured's residence"
“What is the purpose of the Medical Information Bureau? a) To accept or decline insurance applicants b) To set the premium rates for insurers c) To help underwriters evaluate risk
d) To perform physical examinations on applicants - CORRECT ANSWER c) To help
underwriters evaluate risk" "Credit and Health plans are designed to a) permit creditors the ability to require that coverage be purchased through insurers of their choice b) provide permanent protection c) help pay off existing loans during periods of disability
d) not permit free choice of coverage selection - CORRECT ANSWER c) help pay off existing
loans during periods of disability" "Sonya applied for a health insurance policy on April 1. Her agent submitted the information to the insurance company on April 6. She paid the premium on May 15 with the policy indicating the effective date being May 30. On which date would Sonya have coverage? a) April 1 b) April 6 c) May 15
d) May 30 - CORRECT ANSWER d) May 30"
"Which of the following is NOT an eligible dependent on an Accident and Health policy? a) 27 year old married child b) 25 year old married child c) 19 year old full time student
d) unmarried disabled child - CORRECT ANSWER a) 27 year old married child"
"In which of the following situations would the insurer be liable for a loss? a) The insured skipped a payment beyond the 31 day grace period
b) becoming temporarily disabled c) becoming injured on the job
d) becoming cognitively impaired (mentally ill) - CORRECT ANSWER d) becoming cognitively
impaired (mentally ill)" "A medicare supplement plan can be canceled by the insurer a) after the probation period b) for any changes in the insured's health c) anytime
d) for nonpayment of premiums - CORRECT ANSWER d) for nonpayment of premiums"
"Joe is a Medicare participant who receives his benefits through a Managed Health Care Plan. Which Medicare plan does he have? a) Part A b) Part B c) Part C
d) Part D - CORRECT ANSWER c) Part C"
"A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n) a) conditionally renewability clause b) optional renewability clause c) selective renewability clause
d) cancelable clause - CORRECT ANSWER b) optional renewability clause"
"The election of COBRA for continuation of health coverage will a) increase the coverage and lower premium b) maintain the same coverage and increase premium c) increase out-of-pocket costs and lower premium
d) decrease out-of-pocket costs and maintain same premium - CORRECT ANSWER b) maintain
the same coverage and increase premium" "As of January 1, 2014, an employer with up to 25 full time equivalent (FTE's) with average annual wages of less than $50,000 may be eligible for a tax credit of ___ of the premiums paid by the employer. a) 30%
b) 40% c) 50%
d) 60% - CORRECT ANSWER c) 50%"
"Coverage for newborns under an accident and health plan MUST include coverage for a) lost wages of the mother b) disability of the mother c) birth abnormalities
d) delivery costs - CORRECT ANSWER c) birth abnormalities"
"An insurer may refuse to renew an employer's small group health plan due to a) excessive filing of claims b) decrease in the number of employees c) employer's bankruptcy status
d) nonpayment of premium - CORRECT ANSWER d) nonpayment of premium"
"Which of these factors is NOT taken into consideration when determining the cost of a long-term care policy? a) health of applicant b) amount of benefits provided c) age of applicant
d) personal income - CORRECT ANSWER d) Personal income"
"Someone needing custodial care at home would require which type of coverage? a) major medical b) disability c) long-term care
d) medicaid - CORRECT ANSWER c) Long-term care"
"The power given to an individual producer that is not specifically addressed in his/her contract is considered what type of authority? a) discreet b) apparent c) implied
d) express - CORRECT ANSWER c) implied"
"Which of the following statements regarding Group Disability Income Insurance is TRUE?
b) worksite malady c) contagious disease
d) occupational disease - CORRECT ANSWER d) occupational disease"
"A fee for service health insurance plan will normally cover a) vitamins and natural remedies b) cosmetic procedures c) gym membership
d) a disease - CORRECT ANSWER d) a disease"
"Which of the following is NOT a required provision in an accident and health insurance policy? a) legal actions b) grace period c) change of occupation
d) reinstatement - CORRECT ANSWER c) change of occupation"
"A non-admitted insurer a) may sell insurance policies in this state b) is not afforded protection by the guaranty fund c) only applies to foreign insurers
d) may only sell insurance policies through non-admitted agents - CORRECT ANSWER b) is not
afforded protection by the guaranty fund" "Susan is insured through her Group Health Insurance plan and changed her coverage to an individual plan with the same insurer after her employment was terminated. This change is called a(n) a) crossover b) conversion c) exchange
d) extension of benefits - CORRECT ANSWER b) conversion"
"An example of a primary care physician would be a(n) a) internist b) psychologist c) endocrinologist
d) chiropractor - CORRECT ANSWER a) internist"
"Which of these is NOT a TRUE statement regarding HIC's a) urgent care services are provided b) HIC's must establish a complaint system c) HIC's operate on a prepayment basis
d) Benefits are provided on a reimbursement basis - CORRECT ANSWER d) Benefits are
provided on a reimbursement basis" "Respite care is able to provide a) permanent relief to the patient's primary caregiver b) health care to the patient's primary caregiver c) weekly benefit payments to supplement the primary caregiver's income
d) temporary relief to the patient's primary caregiver - CORRECT ANSWER d) temporary relief
to the patient's primary caregiver" "Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit? a) Stop renewing policy when the insured reaches a specified age b) Cancel policy if premiums are not paid c) Increase the premiums on an individual basis
d) increase the premiums on the basis of an entire classification - CORRECT ANSWER c)
Increase the premiums on an individual basis" "An example of endodontic treatment is a a) bridge b) crown c) filling
d) root canal - CORRECT ANSWER d) root canal"
"What is considered to be the primary reason for buying life insurance? a) Provide death benefits b) Provide money for retirement c) Provide living benefits
d) Provide money for college - CORRECT ANSWER a) Provide death benefits"
"When a preferred provider organization (PPO) insured goes out-of-network, which of the following actions occur?
